ICMR moves to check under-reporting of deaths

Aditi Tandon

Tribune News Service

New Delhi, June 26

Amid concerns over potential under-reporting of Covid-19 deaths, the Indian Council of Medical Research has issued key guidance on accurate recording of mortalities.

The National Centre for Disease Informatics and Research (NCDIR), an ICMR institute which runs the National Cancer Registry, in its guidance document shows how comorbidities in Covid patients may enhance the risk of disease but can’t be termed underlying causes of death.

Serological survey in Delhi from today

The Ministry of Home Affairs (MHA) has said a comprehensive serological survey in Delhi will begin from Saturday in a bid to prepare a broad strategy to combat the spread of Covid-19 infection in the national capital.

Aligned with WHO’s International Classification of Diseases-10 Code on Covid mortality, the document says, “It is likely that Covid-19 is the underlying cause of death that led to acute respiratory distress syndrome or pneumonia in most deaths. In these cases, Covid-19 must be captured as the underlying cause of death. Acute respiratory failure is a mode of dying.”

The guidance adds that some patients may present with preexisting comorbidities like asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes. “These conditions increase the risk of developing respiratory infections and may lead to severe disease in a Covid-19 positive individual. These conditions are not considered underlying causes of death as they have directly not caused death due to Covid,” the document notes, with some states auditing Covid deaths and attributing many to comorbidities.

West Bengal tried such auditing, triggering a controversy over under reporting of mortality. The auditing was later revoked. Now Brihanmumbai Municipal Corporation is learnt to be auditing Covid deaths with potential risks of under reporting.

NCDIR has also created India’s first online platform to record hospital deaths, including COVID deaths. The platform called e-MOR (e-Mortality Software) is a smart alternative to the existing paper-based death registration system in India, which is faulty.

“In most death registrations, the causes of death are not accurately recorded. We learnt this when we tried to find the proportion of deaths caused by cancer. In 99 per cent registrations we checked, the cause of death was mentioned as cardio-respiratory failure or septic shock, not cancer despite cancer being the cause. So we developed e-MOR that contains all ICD-10 disease codes, including the COVID code and allows hospitals to electronically feed causes of death.  E-MOR will curb incomplete reporting as it does not let you proceed unless all information slots are filled. Death reporting includes description of the underlying cause, contributing cause and immediate cause. All three are key to epidemiological study,” says NCDIR Director Prashant Mathur.

Karnataka on Friday became the first state to adopt e-MOR for better reporting of COVID deaths. Tamil Nadu and many other states are mulling the idea.

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